EDITOR'S PAGE

AT A GLANCE

In this issue of the Journal, Boudjemline and Bonhoeffer review their experience in pulmonary valve replacement through a percutaneous technique (p.55).Indeed, if a valve can be successfully implanted in the right side of the human heart without open-heart surgery, would not the same be possible for left-sided valves? The authors describe their experimental work in this direction. Their exciting work highlights the expanding clinical applications of nonsurgical interventional therapy. The accompanying editorial (p.61) envisions adoption and incorporation of this technique in various complex congenital reconstructive surgeries.
Knowledge of normal cardiovascular anatomy and physiology is the cornerstone of good diagnostic and therapeutic cardiovascular practice. This is particularly important in the pediatric patient, especially in the newborn and infant. Over the past 20 to 30 years, major advances have been made in the diagnosis and treatment of congenital heart disease in children. As a result, many children with such disease now survive to adulthood. This issue of the Journal spotlights the more common congenital heart disease encountered in adults.
Uncomplicated atrial septal defect occurs in approximately 7% of congenital cardiac defects. Occurring in about one third of the cases of congenital heart disease detected in adults, atrial septal defect is the most common congenital cardiac anomaly in adults, after bicuspid aortic valve. In a mini-symposium on atrial septal defect held at Hamad Medical Corporation, Doha, Qatar, Dr. Numan reviewed its pathophysiology, clinical presentation and diagnosis; the surgical management by Dr. Mckay; and device closure by Dr. Hroob. The proceedings appear on pp.63-83.
Dr. Delemarre (The Hague, The Netherlands) gives a concise review of congenital aortic regurgitation, underlining the importance of early recognition, follow-up, and endocarditis prophylaxis in this group of patients (p.84). Dr. Spitael (Rotterdam, The Netherlands) focuses on the more common congenital aortic wall pathology i.e., sinus of valsalva aneurysm. He summarizes the pathophysiology with clear illustrations, its diagnosis by echocardiography, and treatment guidelines (p.86).
As physicians, we are frequently confronted with moral dilemmas. Dr. Zaglul (Lexington, Kentucky) provides a good general introduction to clinical ethics in the 21st century, with practical guidelines on how one may arrive to an ethical decision (p.92).
Is it of benefit to look back on the past? More than that of any other profession, medicine rests on the observations, wisdom, investigations, and accomplishments of our predecessors. Knowledge of what they have given to medicine and to humanity should therefore be part of our background. Dr. Jacqueline Noonan (Professor Emeritus, University of Kentucky, USA) recounts her recognition of a new syndrome, Noonan syndrome, the mapping of the gene responsible for the abnormality, and the continuing evolution of our understanding of this abnormality (p.102). Her narration includes many players who have contributed to advancing knowledge about the syndrome. Her perspective is forward-looking and that is as it should be. We thank Dr. Noonan for showing us that for medicine to advance, physicians must strive to look to the future as well as look to the past for guidance and inspiration.

                                                  Rachel Hajar, MD